CommercialReimbursementHigh impact
Coordination of benefits claims reprocessing
Harvard Pilgrim Health Care·Reimbursement
We identified it
Jun 20, 2026
Summary
Point32Health (Harvard Pilgrim and Tufts Health Plan) is implementing enhanced coordination of benefits (COB) processes using additional vendors to analyze historical claims data. They will retract payments for claims that were incorrectly paid as primary when they should have been secondary, requiring providers to rebill the primary insurer first.
Action Required
Immediately: Monitor for payment retractions from Point32Health/Harvard Pilgrim/Tufts Health Plan for coordination of benefits issues. When retractions occur, billing team must rebill the primary insurer first, obtain the explanation of benefits, then resubmit to Point32Health as secondary coverage with the primary EOB attached. Review current COB verification processes to ensure primary insurance is correctly identified before initial billing.